Behavioral health providers' beliefs about health information exchange: a statewide survey

Objective

To assess behavioral health providers'' beliefs about the benefits and barriers of health information exchange (HIE).

Methods

Survey of a total of 2010 behavioral health providers in a Midwestern state (33% response rate), with questions based on previously reported open-ended beliefs elicitation interviews.

Results

Factor analysis resulted in four groupings: beliefs that HIE would improve care and communication, add cost and time burdens, present access and vulnerability concerns, and impact workflow and control (positively and negatively). A regression model including all four factors parsimoniously predicted attitudes toward HIE. Providers clustered into two groups based on their beliefs: a majority (67%) were positive about the impact of HIE, and the remainder (33%) were negative. There were some professional/demographic differences between the two clusters of providers.

Discussion

Most behavioral health providers are supportive of HIE; however, their adoption and use of it may continue to lag behind that of medical providers due to perceived cost and time burdens and concerns about access to and vulnerability of information.     

Parental attitudes toward pediatric organ donation: a survey.

We conducted a telephone survey of parents in the National Capital Region to assess their intention to donate their child's organs and to provide physicians with information that could help alleviate their concerns about approaching parents for consent. Of 339 parents who agreed to answer questions after being given details of their child's "death" 288 (85%) said that they would be willing to donate their child's organs. The degree of willingness was associated with the certainty of death, altruism and empathy toward children in need of an organ, previous discussion of organ donation with a family member and knowledge of an adolescent or adult child's attitude toward donation. Factors that inhibited the intention to donate included uncertainty of death, insufficient information from medical professionals and fear of multilation. The child's age was not significantly associated with intention to donate. Concordance between the results and actual donation rates in Canada and the United States supports the generalizability of the survey findings.     

Physician attitudes toward applications of computer data base systems

To determine the attitudes of internists and surgeons to problems in clinical information management and to the use of a computer data base, a survey of 529 internists and 487 otolaryngologists was conducted. The survey group consisted of a national distribution of academic physicians, private practitioners, and residents. Results of 296 completed questionnaires were analyzed for this report. More than one third of all responders were not satisfied with their ability to keep up with new developments; less than 10% were very satisfied. Ninety percent thought that a computer data base would improve their access to information in the literature, and 85% thought it would improve their practice of medicine. Among internists, randomized control trials (RCTs) were viewed as clearly the most useful source of data. Otolaryngologists indicated that RCTs and patient registries were both very helpful. Most physicians indicated significantly greater preference for literature summary and patient registry features over probability estimation capabilities of a computer data base. Sources of data to be incorporated into a successful data base would be different for systems designed for internists and otolaryngologists.     

Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations

ObjectiveRecent policy making aims to prevent health systems, lectronic health record (EHR) vendors, and others from blocking the electronic sharing of patient data necessary for clinical care. We sought to assess the prevalence of information blocking prior to enforcement of these rules.Materials and MethodsWe conducted a national survey of health information exchange organizations (HIEs) to measure the prevalence of information blocking behaviors observed by these third-party entities. Eighty-nine of 106 HIEs (84%) meeting the inclusion criteria responded.ResultsThe majority (55%) of HIEs reported that EHR vendors at least sometimes engage in information blocking, while 30% of HIEs reported the same for health systems. The most common type of information blocking behavior EHR vendors engaged in was setting unreasonably high prices, which 42% of HIEs reported routinely observing. The most common type of information blocking behavior health systems engaged in was refusing to share information, which 14% of HIEs reported routinely observing. Reported levels of vendor information blocking was correlated with regional competition among vendors and information blocking was concentrated in some geographic regions.DiscussionOur findings are consistent with early reports, revealing persistently high levels of information blocking and important variation by actor, type of behavior, and geography. These trends reflect the observations and experiences of HIEs and their potential biases. Nevertheless, these data serve as a baseline against which to measure the impact of new regulations and to inform policy makers about the most common types of information blocking behaviors.ConclusionEnforcement aimed at reducing information blocking should consider variation in prevalence and how to most effectively target efforts.     

Physicians' opinions of a health information exchange

Background

Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE).

Objective

To evaluate physicians'' perceptions regarding AMIE''s impact on health outcomes and healthcare costs.

Measurements

A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding.

Results

A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of “doctor shopping”; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system.

Conclusion

Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.     

Smoking and mental health: results from a community survey

OBJECTIVE: To assess the relationship of smoking with depression and anxiety symptoms and with risk factors for depression. DESIGN AND SETTING: A community survey conducted in Canberra in 1997. PARTICIPANTS: 2725 persons aged 18-79 sampled from the electoral roll. MAIN OUTCOME MEASURES: Smoking was investigated in relation to psychiatric symptoms (anxiety, depression, alcohol misuse), sociodemographic characteristics (age, sex, education, occupational status), social stressors (divorce, unemployment, financial difficulties, negative life events, childhood adversity), personality (extraversion, neuroticism, psychoticism), and social support (family and friends). RESULTS: Smokers had more depression and anxiety symptoms, more stressors and lower socioeconomic status compared with non-smokers. The association between smoking and psychiatric symptoms persisted even when stressors, socioeconomic characteristics and other factors were statistically controlled. CONCLUSIONS: Smoking is associated with poorer mental health. In helping patients to give up smoking, doctors need to be aware that some may have underlying mental health problems that require attention.     

Computerised information exchange in health care

The slowly increasing use of computers in the management of general medical practices may be greatly accelerated if new technologies for the storage and transfer of information are introduced. Electronic data interchange promises to speed the transfer of medical data, insurance information and payments. Smart cards promise a portable, up-to-date, confidential medical record that can be carried by patients. However attractive these new systems may be to computer suppliers and government bureaucracies, it is not certain that they will be as attractive for the general practitioners who will be required to implement the changes. Smart cards may exacerbate problems with the ownership and privacy of data, rather than guaranteeing confidentiality and control. Data exchange through a computer network may allow many information services not actually essential to general practice, while creating serious new possibilities for breaches of privacy. Costs in implementing the new technologies for general practices may outweigh any gains in efficiency, which could in any case be achieved through better use of paper records. The Health Insurance Commission may see advantages in the collection of data on the diagnoses of patients that can be used in epidemiological studies and in the control of overservicing, but there will be practical limitations on the reliability of the data collected by this means. General practitioners should carefully consider their attitude to these new technologies before suppliers, governments and others make their record-keeping decisions for them.     

Patients' perspectives on medical information: results of an informal survey

The autonomy of patients in making medical decisions is increasingly recognised globally, but is not fully adhered to in India. Information is the first step for a patient to be able to make a decision on his or her health care. The objective of this survey was to ascertain patients' perspectives on the amount of information given to them by health professionals. The results of interviews with 222 patients show that perspectives vary, often according to the diagnosis. The amount of information given and the manner in which it is given are often not acceptable to the patient.